Despite a number of trials supporting the administration of quetiapine in patients with acute mania, the evidence supporting maintenance therapy is limited. To date, a 12-month, open-label, randomized trial in 28 bipolar patients is the only study supporting the use of quetiapine as maintenance therapy.

Of interest, an 8-week, placebo-controlled study in patients with bipolar depression was presented at the APA 2004 annual meeting. This study showed a rapid and robust treatment effect as early as week 1.

Strengths:

• Proven acute antimanic effect.
• Possible antidepressant effect.
• Reduced weight gain, hormonal changes, and EPS compared with other atypical antipsychotics.

Weaknesses

• Data on maintenance are limited.
• Associated with somnolence and other side effects.

Guidelines